Outpatient tonsillectomy and adenoidectomy clinical pathways: an evaluative study.
OBJECTIVE
The purpose of this study is to examine two different dimensions of an outpatient pediatric tonsillectomy and adenoidectomy (T&A) clinical pathway at a tertiary care children's hospital. First, the analysis investigates whether the T&A clinical pathway effectively aids in the decision to discharge a pediatric patient as a day surgery (DS) (less than 12 hours) rather than as an outpatient observation surgery (OPO) (12 to 23 hours). Second, the pathway's impact on quality and financial outcomes is explored.


METHODS
Forty prepathway pediatric T&A patients were randomly selected and matched to 40 pathway pediatric T&A patients by age, gender, medical history, and surgeon to form a retrospective cohort. Using chi-square and analysis of variance, the two groups were compared by type of discharge (DS or OPO), length of stay, readmission rates, and costs.


RESULTS
The results show that patients on a pathway were more likely to be discharged as a DS. The shift toward DS discharges effected significant reduction in average length of stay and overall direct costs. Furthermore, there was no difference in readmission rates.


CONCLUSIONS
These results indicate that the development and implementation of a pathway is an effective method in reducing length of stay and overall direct costs while maintaining quality outcomes.
Pestian
J P
JP
Department of Pediatrics, Eastern Virginia Medical School, Norfolk, USA.
Derkay
C S
CS
Ritter
C
C
D000233:Adenoidectomy / Q000191:economics; D000556:Ambulatory Surgical Procedures; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D017046:Cost Savings; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D005069:Evaluation Studies as Topic; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000191:economics